Health and social care devolution: it's complicated

Julia Segar

Following a protest against changes in health services in the Greater Manchester district of Wythenshawe, Dr Julia Seagar explores why this should be seen as more than a local grumble.

'Keep Wythenshawe Special' is a campaign led by clinicians from Manchester's Wythenshawe Hospital. A protest march, judicial challenge and ongoing campaign are all responses to a decision to site some specialist services at Stepping Hill Hospital rather than at Wythenshawe.

This decision is part of the Healthier Together programme that seeks to rationalise hospital care across Greater Manchester (GM). Hospitals are to work together, forming networks and sharing consultant expertise. The decision-makers were representatives of GM's 12 Clinical Commissioning Groups (CCGs).

But this must be viewed as more than just a local grumble. In fact, it has great significance in light of the devolution of health and social care that is part of the Devo Manc initiative rolled out on 1 April 2016.

The Keep Wythenshawe Special campaigners have argued that there has been a lack of accountability in the Healthier Together decision-making process. Leaving aside the particular case of Wythenshawe Hospital, we would argue that the lines of accountability within the new structures for GM's health and social care devolution are complex.

ven without devolution, health and social care organisation is downright complicated. The reforms brought about by the Health and Social Care Act 2012 caused huge upheaval and now GM will have new organisational structures to deliver devolved health and social care . GM has 12 CCGs, ten local authorities, 14 hospital trusts, one ambulance trust, and one NHS England team. The Greater Manchester Health and Social Care Strategic Partnership Board has been formed with representatives from all these organisations. Under this umbrella sit two new partnership groups: a Joint Commissioning Board and a Federation Board.

How these structures will operate in practice is not yet clear; what is though is that an extremely complicated system has received a further dose of complication.

GM's CCGs now commit to look beyond the interests of their own members and patients and take a broader view. Likewise, hospital trusts are being called upon to undertake more co-operative work. This runs counter to the imperative for hospital trusts to compete with one another and for commissioners to 'shop' between providers.

Thus we return to Keep Wythenshawe Special. The aggrieved Wythenshawe clinicians brought their unsuccessful legal challenge against the 12 GM CCGs with whom the trust now sits on the GM Strategic Partnership Board. Organisations accustomed to viewing one another as competitors must now become more closely allied and local accountabilities will have to be weighed against the responsibility under 'Devo' to consider
the wider needs of the GM population.